Does where you live affect your chances of obesity?

More than one in four Canadians live with obesity, but it turns out geography plays a role, with obesity rates varying greatly depending on where you live.

Quebec and B.C. have the lowest provincial rates of adult obesity according to 2019 data from Statistics Canada, with rates of 25.4 per cent and 22.2 per cent, respectively. Ontario has a relatively low rate of obesity as well, with 27.1 per cent of residents living with obesity—slightly lower than last year’s national average of 27.7 per cent.

The Atlantic provinces paint a very different picture, with some of the highest obesity rates in the country. Newfoundland and Labrador is the most obese province, where more than 40 per cent of residents live with this chronic disease. rates in the north are also much higher than the national average. In the N.W.T., the obesity rate is nearly 40 per cent, and in both the Yukon and Nunavut it’s almost 35 per cent.

Statistics Canada measures obesity based on self-reported surveys, which are then adjusted for error. Obesity rates in the provinces are reported annually, whereas territorial rates are reported every two years.

Provincial and territorial differences in obesity rates shouldn’t come as much of a surprise according to Dr. Leia Minaker, who says many factors—ranging from demographics to socioeconomics to the environment—can contribute to these distinctions.

“On the West Coast people are able to be outside all year round and actually bike to work or take active transportation, whereas in northern areas or the East Coast, the snow prevents people from doing this,” says Minaker, assistant professor in the school of planning at the University of Waterloo.

“There may also be differences in access to opportunities with respect to healthy food, and there are probably some elements of provincial cultural differences as well.”

Dr. Jason Gilliland believes much of the geographic variation in Canadian obesity rates can be attributed to relative rurality and remoteness.

“At the provincial level, what we see are those populations living in more remote and rural areas have higher rates of obesity and overweight,” says Gilliland, director of urban development at Western University.

“More high-density cities have more people walking to work and walking to shop because it’s easier, whereas someone in a rural or remote area might have many kilometres to get to a shop or their workplace.”

Canada’s rural areas and small population centres — defined as areas with a population of less than 1,000 and less than 30,000, respectively — both have obesity rates around 33 per cent. This is in stark contrast to the country’s large urban centres, which have populations greater than 100,000, and an obesity rate of 23 per cent.

At a smaller scale, the number of people living with obesity varies by city. Some of the lowest rates are found in Canada’s three largest cities, with Toronto, Montreal, and vancouver having obesity rates of 20.5 per cent, 24.2 per cent, and 19.7 per cent, respectively. Other big cities have similar numbers, including Quebec City, Ottawa, and Calgary, where obesity rates hover around 23 per cent.

Cities with some of the highest obesity rates in the country include Sudbury (32.6 per cent), Thunder Bay (38.30 per cent), Saskatoon (32.2 per cent), St. John’s, N.L. (33.3 per cent) and Saint John, N.B. (41.1 per cent).

Much of the variation between obesity rates in cities boils down to neighbourhood design and opportunity structures — that is, things that are in place to help people lead healthy lives, says Gilliland.

“The way we design our communities has a big impact on our health, and where you live matters,” he says. “The statistics show that places like Montreal, Toronto, and vancouver are best-served with respect to this particular health outcome, so we need to start paying more attention to small and midsized cities.”

Both Gilliland and Minaker note that obesity is extremely complex with many contributing factors, making it challenging to determine exactly what causes differences across Canada.

“Maybe people who value physical activity and eating healthy foods and may be less likely to have obesity cluster themselves in neighbourhoods that have good access to healthy food sources or walkable neighbourhoods,” says Minaker. “It becomes kind of a chicken and egg situation. Geography is one component, but we don’t fully understand the extent to which geographic differences in obesity are causal versus just correlational.”

MORE HIGH-DENSITY CITIES HAVE MORE PEOPLE WALKING TO WORK AND WALKING TO SHOP BECAUSE IT’ S EASIER, WHEREAS SOMEONE IN A RURAL OR REMOTE AREA MIGHT HAVE MANY KILOMETRES TO GET TO A SHOP OR THEIR WORKPLACE .— DR. JASON GILL I LAND